Capitol Hill Report: The Congressional Budget Office

February 22, 2010

The mission of the Academy is to be "indispensable to its members." One way the Academy fulfills this mission is by representing of neurology in the halls of Congress. Capitol Hill Report presents regular updates on legislative action and how the AAN ensures that the voice of neurology is heard on Capitol Hill. The Academy's legislative counsel in Washington, DC, Mike Amery, offers weekly updates on advocacy for neurology and neurologic concerns.

The last two weeks have been tough in Washington, DC, with dual snowstorms shutting down government and travel around the region. Although Congress was periodically in session, nothing regarding health care reform moved forward. Recognizing that reform in its current form is unlikely to pass both the House and Senate, President Obama has called for a February 25 health care summit to be held with congressional leaders on both sides of the aisle. White House Chief of Staff Rahm Emanuel and HHS Secretary Kathleen Sebelius last week sent a letter to 12 Democratic and nine Republican members of Congress formally inviting them to the televised summit.

Because little congressional action took place over the last two weeks, I thought this would be a good time to discuss the Congressional Budget Office (CBO). If you've read this column over the last several months, you will recognize that the Academy has been asking for a CBO analysis for our proposed amendment, which would include neurology as a specialty eligible for the primary care incentive section in the health care reform bills. We have been stopped in every instance by the fact that the CBO has failed as of yet to "score" our amendment.

The Congressional Budget Office

The Congressional Budget Office was founded on July 12, 1974, with the enactment of the Congressional Budget and Impoundment Control Act (P.L. 93-344). The agency began operating on February 24, 1975, with the appointment of Alice Rivlin as the first director.

The CBO's mandate is to provide the Congress with:

Objective, nonpartisan, and timely analyses to aid in economic and budgetary decisions on the wide array of programs covered by the federal budget

The information and estimates required for the Congressional budget process

Based on this mandate, the agency's primary job is to provide budget-related information to all committees of both Houses, with priority given to the needs of the Committees on the Budget and of the Committees on Appropriations, Ways and Means, and Finance. The law also requires the CBO to prepare several budget projections each year and to perform studies of budgetary issues. In addition, the CBO must prepare estimates of new budget authority, outlays, or revenues that would result from bills or joint resolutions reported from committees of either House, and of the costs that the government would incur in carrying out the provisions of the proposed legislation.

The Speaker of the House of Representatives and the President pro tempore of the Senate jointly appoint the CBO Director, after considering recommendations from the two congressional budget committees. The term of office is four years, with no limit on the number of terms a Director may serve; however, either House of Congress may remove the Director by resolution. Douglas W. Elmendorf is the current CBO Director, appointed to serve from January 22, 2009, to January 3, 2011. The CBO currently employs about 250 people. The agency is composed primarily of economists and public policy analysts. About three-quarters of its professional staff hold advanced degrees, mostly in economics or public policy.

Throughout the health care debate, the CBO has been busy. Congressional leaders have frequently had to delay introduction or consideration of provisions due to waiting for the CBO to issue cost estimates. This is what has delayed the Academy's neurology amendment—we just can't get the CBO to score the provision. As far as we know there have been at least four requests by members of Congress requesting a CBO score. Congresswoman Betty McCollum (D-MN) originally received a score estimated to be at $1 billion over 10 years. This represented 50 percent of the entire program, which was absurd on its face and made it clear that the CBO had not really made a careful analysis. This led Sen. Amy Klobuchar (D-MN), as well as the House Energy and Commerce and the House Ways and Means Committees, to request a score. Most recently, I made a request to meet with the CBO to show their analysts the independent score that we received, showing that the amendment would be less than $200 million over 10 years. Unfortunately, they haven't responded.

In conclusion, we hope that as the health care reform debate draws out, the CBO will have more time to consider the neurology amendment. Once we get it, we are hopeful that neurology will not be left behind, if and when, health reform gets moving again.